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Why You Need a Dental Plan for Seniors

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As you age, you may be at increased risk for certain dental conditions, according to the American Dental Association. Dental conditions associated with aging include dry mouth, dental caries (cavities) and periodontitis, a serious gum infection. Physical and cognitive impairments may also make home oral health care difficult for seniors, exacerbating dental problems. You may wish to have a Medicare dental plan to avoid paying out-of-pocket for dental treatment.

Is dental coverage included in Original Medicare?

If you’re a senior over 65 you are most likely eligible for Medicare. Original Medicare (Part A and Part B) covers hospital and medical insurance but does not generally include coverage for routine dental care such as dentures, cleanings, fillings, and extractions. Original Medicare generally only covers dental care in emergency or complicated cases. If you want coverage for routine dental care, you will most likely need a dental plan.

Where can I find Medicare dental plans?

Medicare doesn’t offer stand-alone dental plans to go alongside Original Medicare. If you want dental coverage under Medicare, the only way is through a Medicare Advantage plan with dental benefits. Medicare Advantage is another way to you get your Medicare Part A and Part B benefits from a private insurance company contracted with Medicare. Medicare Advantage plans must cover everything that Original Medicare covers and most plans offer coverage beyond what Original Medicare offers. Additional benefits of Medicare Advantage plans could include routine vision coverage, routine hearing coverage, and prescription drug coverage as well as dental coverage. Keep in mind the dental benefits may vary among Medicare Advantage plans so check with the plan about exactly what it covers. Keep your future needs in mind as you are choosing a plan. For example, you might not have dentures now but you might need in them in a few years.

What do Medicare dental plans cover?

According to the Centers for Medicare and Medicaid Services (CMS) Medicare Advantage plans may cover:

  • Routine dental services
  • Diagnostic services
  • Restorative services
  • Endodontic/periodontal/extractive and prosthodontics
  • Oral/maxillofacial surgery

Are there other Medicare dental plans besides Medicare Advantage?

You might be aware of Medicare Supplement (Medigap) which helps cover certain Medicare out-of-pocket costs, such as coinsurance, copayments, and deductibles. However, Medicare Supplement generally only helps pay for what Original Medicare already covers. Medicare Supplement typically does not offer additional coverage for things like routine dental, routine vision, routine hearing, or prescription drugs. Medicare Supplement would generally only cover dental procedures in emergency or complicated situations, such as if you were hospitalized and needed oral surgery. Medicare Supplement does not generally cover routine dental care such as check-ups, x-rays, cleanings, or extractions.

How else can I get senior dental coverage?

You can purchase a stand-alone dental plan not associated with Medicare to help pay for dental out-of-pocket costs. Most of these stand-alone plans have monthly premiums and annual maximum benefits. You can find dental plans through eHealth here.

You also might be interested in a dental discount plan. A dental discount plan charges a fee and in return gives you discounted rates to see a certain group of dentists.

According to the Mayo Clinic, problems in your mouth can affect the rest of your body. You can contribute to your overall health by taking care of your dental needs.

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